RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2016-01092
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20040824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Security Forces, medically separated for “chronic low back pain due to spondylolysis and bulging disk L4-L5 with spinal stenosis” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his unfitting back condition.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040402	VARD - 20050202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain Due to Spondylolysis and Bulging Disk L5-L5 with Spinal Stenosis	5237	10%	DDD with Chronic Low Back Pain and Congenital Spinal Stenosis	5242	10%	20041105	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain Due to Spondylolysis and Bulging Disk L4-L5 with Spinal Stenosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began acutely in April 2002 after rising from a sitting position.  The CI participated in a basketball tournament the day before.  Magnetic resonance imaging (MRI) studies on 19 May 2003 showed a moderate-size broad-based central disc herniation which mildly narrowed the lateral recesses.  There was also mild bilateral neural foraminal narrowing and spinal canal narrowing.  Plain films demonstrated bilateral L5 pars defects with retrolethesis of L4 on L5.  
The 11 December 2003 MEB NARSUM examination, 8 months prior to separation, noted complaints of sharp pain, worse with flexion, but that did not radiated into his legs.  Physical examination showed “full range of motion (ROM) except limited forward flexion (to about 60 degrees only) due to pain.”  There were no muscle spasms or tenderness at the time of the examination.  Strength was normal and there were no gross neurologic deficits.  

At the 5 November 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported constant low back pain, rated 5/10 with increased activity depending on his activity.  Prior complaints of radiation to the thighs had resolved.  He denied any incapacitating episodes in the past 12 months.  Physical examination showed normal strength, sensation and reflexes.  Straight leg raise was negative on the right and positive on the left for radicular symptoms.  Gait was normal.  Thoracolumbar ROM measurements showed flexion of 90 degrees (normal 90) and combined ROM of 240 degrees (normal 240) after repetition, with complaints of pain on flexion and extension.  The CI was able to walk on his toes and heels without difficulty and perform a full squat.  There was no change in ROM measurements on repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbar spine strain) stating that the CI was doing well, but the back condition was incompatible with long term rigors of military service.  On appeal of the Formal PEB (FPEB), requesting return to duty with cross training, FPEB adjudication was upheld by the Secretary of the Air Force Personnel Council.  The VA also rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination 2 months after separation, citing increased pain with activity and painful motion.  

The panel noted the MEB NARSUM examination did not provide ROM measurements using a goniometer.  ROM was reported to be “full range of motion except limited forward flexion (to about 60 degrees only) due to pain.”  The only other service ROM measurement was from 12 months prior to separation which documented forward flexion of 30-45 degrees.  The VA ROM examination was completed 2 months after separation (closest to separation), was more detailed, and was compliant with VASRD rating guidelines.  Therefore the panel majority placed greater probative value on the VA examination.  

Based on the probative VA examination, the panel agreed there was no limitation of thoracolumbar spine motion to support a minimum rating under the General Rating Formula for Diseases and Injuries of the Spine; however, the examination noted the presence of painful motion.  A 10% rating was therefore warranted.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The single voter for dissent recommended modification to 20% and did not elect to submit a minority opinion.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01092.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings